Some heavier reading this week, in keeping with the Milestones for somatic therapies this month.
How do you determinine if an antipsychotic medication will work? What outcome measures will you use? Is there some way to tell whether Medication A will be better than Medication B, and if so how--and how clinically meaningful is that difference.
Attached is a large randomized open trial, Effectiveness of antipsychotic drugs in first-episode
schizophrenia and schizophreniform disorder: an open
randomised clinical trial, (René S Kahn*, W Wolfgang Fleischhacker*, Han Boter, Michael Davidson, Yvonne Vergouwe, Ireneus P M Keet, Mihai D Gheorghe,
Janusz K Rybakowski, Silvana Galderisi, Jan Libiger, Martina Hummer, Sonia Dollfus, Juan J López-Ibor, Luchezar G Hranov, Wolfgang Gaebel,
Joseph Peuskens, Nils Lindefors, Anita Riecher-Rössler, Diederick E Grobbee, for the EUFEST study group†. Lancet 371: 1085-97, 2008), that asks these questions. Note too, the role of adherence and discontinuation in the outcomes. As I've often said, "the best medication for the patient is the one that they actually take".
The second article is a major metaanalysis comparing antipsychotic medications against one another (and placebo). Comparative efficacy and tolerability of 15 antipsychotic
drugs in schizophrenia: a multiple-treatments meta-analysis. (Stefan Leucht, Andrea Cipriani, Loukia Spineli, Dimitris Mavridis, Deniz Örey, Franziska Richter, Myrt. Lancet 382: 951-62, 2013) I'm simply impressed with the scope of this. Who comes out ahead, and why? The exercise is left to the reader, as they say.
Effectiveness of antipsychotic drugs... Kahn, et al.
Comparative Efficacy..., Leucht, et al.
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